When I first saw a photo of a hemostatic net, I thought it was crazy. It looks like this snake pattern of sewing on the skin. A hemostatic net is where we use a suture to tuft or quilt the skin so that fluid (blood) can’t accumulate under the skin flaps. This was started to reduce the incidence of hematoma, which ranges from 2-14% in facelifts. People who are at increased risk for a hematoma:
- Full neck lift with platysma surgery
- Blood pressure greater than 150mm
- Men
- NSAID use (Advil, motrin, ibuprofen)
- Smoking
Other techniques have been tried in the past- fibrin sealants, using many different blood pressure management techniques, and drains placed at surgery. Although these do reduce hematomas, non is superior.
So what is this net?
This was out of the Aesthetic Surgery Journal October 2023, “Hemostatic Net in Facelift Surgery: A 5 Year Single Surgeon Experience.” Study was done in 304 patients. No patients with the net has drains. Hematoma (a collection of blood) is defined as more than 20cc of fluid.
How do they do it? They use a 5.0 polypropylene (prolene) suture with a 25mm 3/8 circle cutting needle. The needle is placed at 90 degrees the skin to compress the skin against the underlying SMAS. The sutures are placed approximately 1 cm across and 1 cm from each other, with moderate tension and tied in the hairline, being careful to not make it blanch. This quilting is done on the skin which was undermined for the facelift. A typical amount in their study was “2 columns in the face and 3 columns in the neck/postauricular area.” These sutures were removed after 48 hours by cutting each individual suture. The skin was cleaned with chlorhexidine prior to removing the suture. They recommend the patient rests for half an hour after suture removal.
Discussion:
They talk about the excellent safety profile of this technique. They show in their practice their hematoma rate went from 3.9% to 0.6%, and they state that this rate is now zero after their learning curve. In their male patients, who are higher risk, their hematoma rate was 0%. Though there is risk of skin necrosis or flap loss, none was seen in their study.
Negatives?
Some people do describe pigmented scars from suture tracks, thought to be caused by inflammation causing pigmentation. This improved when they switched from 4.0 nylon suture to the finer 5.0 nylon suture. In this study they used 5.0 prolene which they said had low rates of pigment issue. There was also a report of temporary nerve injury. Lastly, they state that it increases operating time. The authors state that with practice, the application of the net takes 7-10 minutes.
My thoughts?
If a patient has bleeding/oozing during surgery, a history of high blood pressure, or is male, I think this is good. The issue of “track marks” is a real one with any skin pigment, so watching for this and removing sutures early is important. For sure a good tool for our toolbox.